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Counties differ on vaccine approach

In the Reno area, if you're between the ages of 25 and 64 with a chronic medical condition such as diabetes or asthma, you can receive an H1N1 flu shot from the Washoe County Health District.

If you fit that criteria in Las Vegas, you can't get one from the Southern Nevada Health District.

So why the difference when according to the federal Centers for Disease Control and Prevention this set is one of the groups that should be first in line to receive the vaccine?

It comes down to this: Although there is a shortage of vaccine, Washoe County public health officials do not want to prioritize among the five high-risk groups, while Clark County authorities think it's necessary.

"One high-risk group is just important as another," argues Dr. Randall Todd, chief of epidemiology and public health preparedness for Washoe County.

Brian Labus, a senior epidemiologist with the Southern Nevada Health District, said last week, "Sometimes we have to make difficult decisions about how to do the best with what we have."

Under CDC guidelines, both public health approaches are acceptable. In a shortage situation, according to the CDC, the 25-64 group with chronic medical conditions can be excluded from receiving the vaccine.

But there is some good news for Clark County residents in this group.

Private physicians dispensing the vaccine in Southern Nevada don't have to abide by the local health district's protocol. They must agree to vaccinate only those listed in CDC priority groups: pregnant women; caregivers or those with children under 6 months old; health care workers and emergency responders; those between 6 months and 24 years old; and people between 25 and 64 with chronic health conditions.

That good news is tempered by the fact that the health district here has distributed only about 11,000 doses of vaccine to private practitioners and hospitals while keeping most of its supply, nearly 70,000 doses, for district clinics.

Dr. Tony Alamo, an internist who operates Alamo Medical Clinic in Henderson, said Thursday he has received only 300 doses of H1N1 vaccine in the past three weeks and expects to be out by the end of the week.

"The best way this should have been handled, like any other vaccine, including the seasonal flu, is to get it into the hands of the primary care physicians who care for the people of America," he said.

Todd agrees.

"We've pushed the majority of the 19,000 doses we had to private practitioners because we thought they were closer to people," Todd said. He said his Northern Nevada health district kept only 3,500 doses for its clinics.

This week, Todd said, his district expects to receive an additional 8,500 doses; he does not know how much will be kept for clinic use.

On Saturday, both health districts will hold special clinics.

Todd said that in three clinics held by Washoe health officials, more than 600 people in the 25-64 category were vaccinated. Statewide, it's unknown how many vaccines have been given by private physicians.

Because Alamo's clinic serves about 15,000 patients, most of them between the ages of 40 to 70, he said he has tried to vaccinate the most at-risk: those with conditions such as asthma, emphysema, diabetes and high blood pressure.

He said he has vaccinated "by the book" to the CDC's priority guidelines.

"We deal with internal medicine, so it's a very small number of kids that we see here, and no pregnant women," he said.

"I guess at the end of the day, we can only wait and hope the federal government gets a handle on how to deliver the vaccine," Alamo said.

Jennifer Sizemore, a spokeswoman with the Southern Nevada Health District, said Clark County health officials think that because of the county's large population, about 2 million, the best way to reach residents is through health district clinics. Washoe County has about 418,000 residents.

Sizemore said public health officials took into account the fact that people who go to a private practitioner have to pay an administrative fee for a flu shot, often around $20, whereas there is no charge for a shot given at a district clinic.

Also, a lack of patient screening could be part of the reason that people in the 25-64 age group with medical conditions -- who can take safely only the shot version of the vaccine -- have not been able to get vaccinated in Clark County.

During the last clinic in which the injectable vaccine was available, held last month, several people in line for the shot could have taken FluMist but said they were never told by health district officials they could take the inhaled version.

Stephanie Bethel, a health district spokeswoman, who said that won't happen Saturday, thinks that if the inhaled version of the vaccine had been more widely used, the injectable vaccine probably could have been offered to the adult at-risk group.

Todd said that clients in Washoe County must show a photo ID and give written details about what kind of underlying medical conditions they have.

Though Clark County public health officials have said they have a shortage of injectable vaccine, they've been sitting on about 6,000 doses since last month.

Dr. John Middaugh, the district's director of community health, previously said it is being saved in case pregnant women and people from other priority groups need it.

"We aren't sitting on vaccine here (in Reno)," Todd said. 'We don't have a problem with the supply getting down to zero. We want to get it out to the people in all the priority groups as fast as we can."

Of the 20 people who have died of swine flu locally, all have been adults, and at least 12 with underlying medical conditions were in the 25-64 range

But Labus has said that the number of deaths, though tragic, is not enough to alter public health policy.

He said the highest rates of flu involve those ages 10 to 14, with 400 cases per 100,000 Clark County residents. That is about eight times as many as many as those in the 40- to 44-year-old age group.

"The highest rate by far is people under 20," he said, noting that when supplies are scarce, officials target the group where there is the most disease.

If Clark County residents between the ages of 25 and 64 with medical conditions can't find a private doctor to give them a shot, Todd said, they are welcome to come to the Northern Nevada health district's clinic on Saturday.

"It will be expensive and time-consuming for them, but we won't turn them away if they're in a priority group," he said.

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